MATERNAL AND FETAL OUTCOMES IN ANTEPARTUM ECLAMPSIA PATIENTS ADMITTED IN TERTIARY CARE CENTRE: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Antepartum eclampsia is one of the most severe manifestations of hypertensive disorders of pregnancy and remains a major contributor to maternal and perinatal morbidity and mortality, particularly in developing countries. Despite improvements in antenatal surveillance and obstetric critical care, delayed diagnosis, inadequate antenatal care, and late referral continue to adversely affect maternal and fetal outcomes. Evaluation of the clinical profile and outcomes of antepartum eclampsia is essential to identify preventable risk factors and improve management strategies. Objectives: To evaluate maternal and fetal outcomes in women with antepartum eclampsia admitted to a tertiary care centre. To study the mode of delivery. To identify demographic and obstetric factors associated with adverse outcomes. Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital over 18 months after Institutional Ethics Committee approval. A total of 258 women diagnosed with antepartum eclampsia beyond 28 weeks of gestation were enrolled. Women with seizures due to causes other than eclampsia were excluded. Detailed demographic, clinical, obstetric, laboratory, and outcome data were collected using a structured proforma. Maternal variables included age, parity, socioeconomic status, educational level, antenatal care, gestational age, blood pressure, number of convulsions, proteinuria, mode of delivery, maternal complications, ICU admission, and maternal mortality. Fetal variables included birth weight, gestational maturity, Apgar score, NICU admission, stillbirth, neonatal complications, and perinatal mortality. Statistical analysis was performed using Microsoft Excel. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. A p-value <0.05 was considered statistically significant. Results: Among the 258 patients, the majority (52.33%) were aged 21–25 years, 70.54% were primigravidae, and 78.68% belonged to the lower socioeconomic class. Most women (62.79%) were illiterate, and 51.94% were from rural areas. Moderate-to-late preterm gestation (32–36.6 weeks) constituted 47.67% of cases. Irregular antenatal care was observed in 46.51% of women, while 7.36% had received no antenatal care. Two convulsive episodes occurred in 58.53% of patients, and severe hypertension (≥160/110 mmHg) was present in 35.66%. Moderate proteinuria (+2) was the most frequent finding (64.73%). Maternal complications included HELLP syndrome, disseminated intravascular coagulation, pulmonary oedema, acute kidney injury, postpartum hemorrhage, and ICU admission in severe cases. Fetal complications comprised prematurity, low birth weight, fetal distress, NICU admission, stillbirth, and neonatal mortality. Adverse maternal and fetal outcomes were more common among women with inadequate antenatal care, delayed referral, multiple convulsions, severe hypertension, and lower socioeconomic status. Conclusion: Antepartum eclampsia continues to be associated with significant maternal and fetal morbidity despite advances in obstetric care. Young primigravid women from socioeconomically disadvantaged backgrounds remain the most affected group. Early identification of hypertensive disorders through quality antenatal care, timely referral, prompt administration of magnesium sulphate and antihypertensive therapy, multidisciplinary management, and availability of intensive maternal and neonatal care can substantially improve pregnancy outcomes. Strengthening community awareness and referral systems is essential for reducing the burden of antepartum eclampsia and preventing avoidable maternal and perinatal deaths.